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From the forest to the clinic: changing birth practice among the Katang, Lao.

It is the right of indigenous peoples to maintain traditional cultural practices but women's right to reproductive health may be compromised by the very beliefs and practices that define culture. Based on interviews with Katang villagers and a range of local medical practitioners, this paper describes how the Katang people of Lao are coming to terms with this dilemma in a context of development and change. Indigenous religion prohibits Katang women from giving birth in the house; traditionally they go into the forest for delivery. The birthing hut (an innovation in one village), training of six TBAs, the opening of a primary level clinic where normal births can take place and growing awareness of the need for referral to higher levels of care in case of complications are all changes that are transforming women's childbirth experience. As these changes become established, and awareness grows in the local communities of the importance of being able to access services in a timely way, the possibility of reducing maternal deaths will become a reality.

Attitude to Health↗

Global/local scoring modifications for the Rey-Osterrieth Complex Figure: relation to unilateral temporal lobe epilepsy patients.

Observation of figural reproductions of right temporal lobe epilepsy (RTLE) patients have revealed overall configuration errors, whereas in left temporal lobe epilepsy (LTLE) patients, the global aspect of performance is generally preserved. This study compared performance of individuals with temporal lobe epilepsy (LTLE, n=83; RTLE, n=63) on a global/local modification of the Rey-Osterrieth Complex Figure Test (RCFT). In Phase I, neuropsychologists (n=6) and neuropsychology fellows (n=3) completed a survey identifying the global and local aspects of the RCFT. Questionnaire responses were used to categorize a list of global and local items (five global, five local) for re-scoring the protocols of TLE patients during study Phase II. Results showed that the RTLE and LTLE groups were not differentiated according to the global or local indices F(1,141) = .385; p = not significant. There were lower local scores for both groups in the copy F(1,142) = 5.23; p = .024, immediate F(1,142) = 445.26; p < .001, and delay trials F(1,142) = 427.82; p < .001, indicating less retention of local information over time. Results suggest general declines in figural memory for local stimulus properties in both unilateral TLE groups. However, this relationship was weakened after controlling for global and local item verbalizability.

Adult↗

Qualitative methodologies and community participation in examining reproductive experiences: the Harlem Birth Right Project.

OBJECTIVES: Racial disparities in health present a challenge to public health because of the complexity of interacting social forces. The Harlem Birth Right Project sought to improve understanding of these forces by using qualitative and community participatory methods. In this paper we 1) describe the process of qualitative inquiry and community involvement, 2) evaluate the impact of community participation, and 3) present a brief summary of the findings on social context as it relates to pregnancy outcomes of women in Harlem. METHODS: We operationalized the qualitative method by combining participant observation, longitudinal case studies, and focus groups. An ethnographic survey was used to verify and triangulate findings across methods of data collection. We involved the community in the design, implementation, and analysis by collaborating with community-based organizations, setting up a community advisory board, and the use of dialogue groups and community meetings. RESULTS: The use of qualitative methods and community partnership uncovered important aspects of the social context of women's lives that may not have emerged through traditional epidemiologic research. We found that pregnancy may serve as a catalyst to increase perception of the magnitude of preexisting social stressors. Several stressors and chronic strains associated with structural forces were identified. For example, the high percentage of households headed by women is seen as one consequence of larger structural forces. While social support networks serve as an important coping mechanism to buffer against the stress caused by these structural forces, the types of support women seek differs by social strata, and some strategies were identified as being substantially more effective than others. CONCLUSIONS: Qualitative and community participatory research can be successfully conducted to support public health goals and can derive important new information on the social context of women's lives.

Community Participation↗

Human germ-line therapy: the case for its development and use.

The rationale for pursuing the development and use of germ-line selection and modification techniques is examined in this essay. The argument is put forth that it is the moral obligation of the medical profession to make available to the public any technology that can cure or prevent pathology leading to death and disability, in both the present and future generations. Society should pursue the development of strategies for preventing or correcting, at the germ-line level, genetic features that will lead to, or enhance, pathological conditions. Because prenatal screening and even early embryo screening and selection can prevent only a subset of known genetic disorders, direct genetic intervention is the only way in which certain couples can exercise their rights to reproductive health. Finally, the arguments most often raised against the pursuit of and use of methods for germ-line intervention shall be discussed.

Biomedical Research↗

Two kinds of potentiality: a critique of McGinn on the ethics of abortion.

In Moral Literacy, or How to Do the Right Thing, Colin McGinn proposes a consequentialist solution to the abortion dilemma. McGinn interprets moral rights and moral interests as attributable only to actually sentient beings by virtue of their ability to experience pleasure or pain. McGinn argues against the moral rights of potentially conscious human fetuses, on the grounds that the unjoined ova and spermatoza of any fertile men and women are also potentially sentient, but we do not generally suppose that unjoined human genetic germ plasm has moral rights. I argue that McGinn's reply equivocates between two different senses of 'potential sentience.' I distinguish between strong and weak potentiality, or between naturally probably potentiality and merely logically possible potentiality. I agree that it is reasonable to deny that a weak or merely logically possible potentially sentient fetus that would result from any unjoined ovum and sperm has a moral right to life. But I claim that this fact does not diminish the plausibility of extending a moral right or potential moral right to life to a naturally probable potentially sentient fetus, which we have good reason to believe will actually become sentient in the natural course of things if nothing is done to prevent its normal development. I conclude that it is not merely the potentiality, but the strong potentiality of a healthy, normally developing fetus that is soon to acquire sentience, moral interests, and, on McGinn's own terms, a moral right to life, that continues to sustain the abortion controversy, even among those who also want respect a woman's right to reproductive self-determination.

Abortion, Induced↗

The pill of choice?

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Abortifacient Agents↗

Medical negligence and wrongful birth actions: Australian developments.

Wrongful birth actions aim to compensate litigants who are negligently deprived by health professionals of their right to reproductive choice. Access to safe and legal abortion is integral to the action and wrongful birth claims in the United Kingdom have been facilitated by the Abortion Act 1967 (as amended). The recent Australian case CES v Superclinics (1995) 38 NSWLR 47 shows how judicial confusion about the legality of abortion can result in judges condoning medical negligence. The Superclinics case also suggests that doctors are not required to provide pregnant women with the same standard of care as other patients. These developments show that law can become incoherent and health professionals can act negligently with impunity when reproductive choice does not have a secure legal foundation.

Abortion, Legal↗